Permit (132) Illig
CITY OF TIGARD ELECTRICAL PERMIT
F " COMMUNITY DEVELOPMENT Permit#: ELC2019 00592
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2019
Parcel: 1 S 135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD 160
Project: Dr.John Chung Subdivision: None Lot: None
Project Description: Electrical for TI.
Contractor: FIVE STAR ELECTRIC, INC. Owner: TV5 LLC
756 SW BAILEY AVE 10855 SW CASCADE BLVD
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-324-0948 PHONE:
FAX: 503-324-0973
FEES
Quantity Description Date Amount
1 ea Limited Energy 09/19/2019 $75.00
Specifics:
25 crt Branch Circuits wo/Purchase 09/19/2019 $234.26
Service or Feeder
Type of Use: COM 1 ea Plan Review Electricial 09/19/2019 $77.32
Class of Work: ALT 1 ea 12%State Surcharge- 09/19/2019 $37.11
Type of Const: Electrical
Occupancy Grp:
Total $423.69
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 952-001-0090. Yrou may obtain a ••.. ; ules or direct questions to OUNC by calling 503.232 .a."' '''."44‘11/
.1987 or 1.800.332.2344.
r
/ `
Issued By: j' . Permittee Signature:
6/1-- t '
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application RECEIVED FOR OFFICE L'SE ONLY
Cityof Tigard Received ( /.,,e
�ooz0l9`��
• - ® g SEP 2 9 Date/By: ! / Pe 1 [
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie �'
Phone: 503.718.2439 Fax: 503.598.196bITY OF TIGARD Date/By: �� /q ��� G� ?
Inspection Line: 503.639.4175 BUILDING DIVISION Read Date/By: , is: g�
T I G A R D Y ® See a
Internet: www.tigard-or.gov ,�Notifie, ... i,, Supplemental Information
/iii/»ii /.viim! .
�fsm
ME OF WORK 9' ' d p''' PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition �' ❑Service or feeder 400 amps or more 0 Building over three stories.
0 where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRfJCTJON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
El Fire pump. 0 Installation of 150 KVA or
JOB SITE D4FOR1►IATION.AND LOCATION 0 Emergency system. larger separately derived
Job#:FS7784 I Job site address: 11565 SW Hall Blvd ❑Addition of new motor load of system.
I OOH'or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
®Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 160 Project name:Dr.Chung Dentistry 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
FEE SCHEDULE
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
", ,,, . ---m---,-,*-**'''''"-*** Limited energy,residential
UP^,,- � [ 7� ( y c t�,n{�r�,C ( (with above sq.ft.) 75.00 2
AD&A ) ,�"�"Il '� "�i `v'f�J`(f t t`'' S i ad. 't Limited energy,multi-family 75.00 2
IV '(.1\j,
'St f)k F 1 1 Wu/ residential(with above sq.ft.)
❑ PROPERTY OWNER U TENANT ' Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Five Star Electric,Inc, above service or feeder fee,
7.42 2
each branch circuit
Contact name:Becca Sinner B.Fee for branch circuits without
Address:756 SW Bailey Ave service or feeder fee,first I 56.18 56.18 2
branch circuit
City/State/ZIP:Hillsboro,OR 97123 Each add'l branch circuit 24 7.42 178.08 2
Miscellaneous(service or feeder not included)
Phone:(503)324-0948 I Fax: :(503)324-0973 Each manufactured or modular
Email:bsinner@fivestarelectric.org
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
` CONTRACTOR Pump or irrigation circle 67.84 2
i._ ,, 1-
mss'S �; C. St o' h _ . .b'7.S4 _.__
Signal circuit(s)or limited-energy
Address:756 SW Bailey Ave l.See Page 2 '�� 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)324-0948 Fax:(503)324-0973 Investigation(1 hr min) 90.00/hr
Email:bsinner@fivestarelectric.org Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 158231 I Electrical Lic.: 34-665C I Suprv.Lic.:55-- 40 5 specifically listed('A hr min)
— ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requir-:, Subtotal: .309.2-LP
Print name: , ' . c c4-C.12„:, v,L Date: 9, / 'r Ei Plan Review Required(25%of permit fee): 11, 32,
State surcharge(12%of permit fee): .3-1.. ti.: r
Authorized signature: TOTAL PERMIT FEE: 4 Z 3.t l
/ This permit application expires if a permit is not obtained within 180
Print name: ;E lv ,tCG.,l� Date: f/55719 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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•
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE scHrpu>,
Fee for all residential systems combined: $75.00 Descriptionr Qty. Each
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
COMMERCIAL WORK ONLY: ` ` ELECTR-CAL PERMIT FEES ,,
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
tf3, Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015